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Please pMl or type.(Form deslegned for use on elite(12-pilo))4ppewriter.) ;:orm Approved.OMB Na.20540-0035 <br /> UNIFORM HAZARDOUS 1 Generator 10 Numter2 Page 1 of 3.EmergerKy Response Phone 4.Manifest TracktNumber <br /> WASTE MANIFEST ICAL00OU97CZ 1 7 112"69346 <br /> s. a me and 148110 q Addmss Generators Sito s iif rent than mal sg address <br /> Manteca Unified School❑istrict (Sura High) <br /> 1700 T1xm1€Is Sty ' <br /> Manteca, CA %337 tx�t Cz' <br /> Generators Phone 20 111:1= <br /> 8. rn.03 on,pany Namie <br /> U.S.EPA ID Number <br /> Ady5nced Chemical Transport Inc. (SV) GAROOW7 r� <br /> 7 TransporlW 2 Company flame U S.EPA A Number <br /> a DesignAed Far hlr NamR mid Site Address U.S.EPA E]Number <br /> US Ecolo Nauada Inc <br /> PD Box 578 }may 8 ,11 Arles S Beatty NV1330010000 <br /> Beatty, NV 69003 <br /> radii s Phone: 775-553-M <br /> ga, 9b.U.S.DOT Description(Indudirg Proper Shipping Name,Hazard Class.10 Numher, 0 Con'a:ners 11.Total 12,Unit <br /> HM and Packing Group(f arty)) No. Tvpe Quantity WI.Nd 13-vreslo Codes <br /> WANK,Hazardous waste,liquid,n.o.s.(P] Silver <br /> x sciutlottl) ,9,PGZ OF P 0011 541 ' <br /> Z 2, <br /> w <br /> t9 <br /> 3. <br /> a <br /> i <br /> �4 sµ;calHlinl6ngliisuuctionaand AddlibriallnlonnsGon Project Number 153889 Document#7 D185709 <br /> 1)ERC*171; 070137750.271 MALL 00_ ____ <br /> 15-e4 <br /> 15. GENERATOR'S(OFFERDR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and eccuretey described above by the proper shipping name,and are tjasattud,packaged, <br /> mariced and labele ftlacarded,and are n all respects In proper condition for Iransoort according to a#.caNe inte.mationa'enc nations,governmental regAtions.d e)pW shipment and I am the Primary <br /> Exporter,I certify that the contents of hs consignment crmform to the terms of the attached EPA Acknowredgment of Consent. <br /> certify that the haste milimizadon statement idendrred in 40 CFR 262.27(a)(if I am a large nuarrltly gmera�r)or(bl(d I am a small grarbly gervartor)is true. <br /> Generator.' s print ypeca urn M <br /> T- �.-'JA I I'094Z I I <br /> 5hlpms16 <br /> i Import to U.S- LJ F Mrl from U.S. Port of entry!art <br /> Trans over Bigrouro Ifor ca its only): pate lerrvnn U.S, <br /> 17.TransporterAcknoudedgment of Racal of Materials <br /> �2 Wji rF, A"' <br /> co 4-rpi� � .r � 1�? I <br /> ZTransponor 2 Pnnhad ypw Name Month Dav Vaff <br /> 18.Discrepancy <br /> 18a Discrepancy krd,r2lion Space ❑ Quantty EIType ❑Residue Il Partial Rejevion ❑Ful Rejection <br /> Manllest Ralarence Number. <br /> 15b.A temate Faca<ty(u,Generator) U.S.EPA ID Number <br /> U <br /> a <br /> F ,# Phe: <br /> 18c.arylSignature's on <br /> LLJof A11.;Ju FaclritV for Generator) Muth pay Year <br /> tc <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i a..codes for hazardous vvaSta teeatmert,disposal,and recycttlg systems) <br /> p t- 1, 2. 3. 4. <br /> 20.Des gorged Fortify Owner or :C of moislpt of hazardous materials covered by the manifed except ss In barn lea <br /> Pnn Sgnature Month <br /> [M, V—u A ;� <br /> EPA Form 8700-22(Rev 3-t�--Vrevsoua editions are obsolete. DESI ATED FACILITY TO DESTINATION STATE(F R D RED) <br />